Reliably Quantifying Bone Metastases in Prostate Cancer

Although bone is the most common site of distant metastases in prostate cancer, reliably evaluating the extent of metastatic burden is a challenge and has been a limiting factor for clinical decision making as well as in clinical trials. Although limited in terms of specificity and sensitivity, bone scan remains the most often used imaging modality for diagnosing and following bone metastases in prostate cancer. One of the objectives of the Prostate Cancer Working Group (PCWG) was to establish criteria for progression in the bone, which could help level the playing field among clinical trials when establishing radiographic progression-free survival (PFS). The PCWG criteria have aided in making clinical trial results comparable with each other. However, the difficulty in establishing burden of metastases at baseline and evaluating response and progression with the same level of precision as for visceral and measurable disease has slowed down the speed at which clinical trials are able to report conclusive results. This difficulty has likely delayed the establishment of new therapeutic options and may have prevented some potentially active agents being brought to market and available to patients.

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